Why is dexamethasone used for meningitis?
Early intravenous administration of glucocorticoids (usually dexamethasone) has been evaluated as adjuvant therapy in an attempt to diminish the rate of hearing loss and other neurologic complications as well as mortality in selected patients with bacterial meningitis.
Why are steroids used to treat meningitis?
It is caused by bacteria that usually spread from an ear or respiratory infection and is treated with antibiotics. Corticosteroids are drugs that can reduce the inflammation caused by infection. This inflammation has been shown to aggravate damage to the nervous system in experimental meningitis studies in animals.
Which drug is used for H influenza meningitis?
Ceftriaxone is one of the most commonly used antibiotics. Ampicillin may sometimes be used. Corticosteroids may be used to fight inflammation, especially in children. Unvaccinated people who are in close contact with someone who has H influenzae meningitis should be given antibiotics to prevent infection.
What is the best treatment for Haemophilus influenzae?
Antibiotics and supportive care are the mainstays of treatment for Haemophilus influenza infections. Initially, invasive and serious H influenzae type b (Hib) infections are best treated with an intravenous third-generation cephalosporin until antibiotic sensitivities become available.
Should you give steroids in meningitis?
Since treatment with steroids reduces both mortality and neurological sequelae in adults with bacterial meningitis, without detectable adverse effects, routine steroid therapy with the first dose of antibiotics is justified in most adult patients in whom acute community-acquired bacterial meningitis is suspected.
When do you give steroids in meningitis?
Since early therapy reduces morbidity and mortality,17 treatment with dexamethasone and antibiotics should be initiated before lumbar puncture in all patients with suspected meningitis who must undergo cranial CT first. Two important issues are the duration and timing of dexamethasone therapy.
How is H. influenzae meningitis treated?
Ceftriaxone is one of the most commonly used antibiotics. Ampicillin may sometimes be used. Corticosteroids may be used to fight inflammation, especially in children. Unvaccinated people who are in close contact with someone who has H influenzae meningitis should be given antibiotics to prevent infection.
Which drug is used in serious H. influenzae infection?
The important antibiotics applied in the treatment of less severe H. influenzae infections include amoxicillin, cephalosporin, azithromycin, doxycycline, and fluoroquinolone. However, serious infections are managed by broad-spectrum cephalosporins and carbapenems (1,2).
What is the virulence factor of Haemophilus?
capsular polysaccharideThe capsular polysaccharide of Haemophilus influenzae serotype b [(3)-beta-D-ribose-(1-1)-ribitol-5-phosphate] is a major virulence factor and a target for serum antibodies which protect individuals against invasive infections.
Which serological method is used for identification of H influenza?
H. influenzae can be identified using Kovac's oxidase test and determining the necessity of hemin and NAD as growth requirements. If the oxidase test is positive, hemin and NAD growth factor requirement testing should be performed.
Does azithromycin treat H. influenzae?
Azithromycin is an azalide with potent activity against Haemophilus influenzae including ampicillin-resistant strains.
Does ceftriaxone cover H. influenzae?
Directed parenteral therapy for pneumonia and bacteremia due to H. influenzae includes ampicillin for β-lactamase-negative, ampicillin-susceptible strains and ceftriaxone, cefotaxime, or cefuroxime for β-lactamase-positive strains (15).
Prognosis
Research
- Many controlled trials have been performed to determine whether adjuvant corticosteroid therapy is beneficial in children with acute bacterial meningitis. The results, however, do not point unequivocally to a beneficial effect. A meta-analysis of randomized controlled trials performed since 1988 showed a beneficial effect of adjunctive dexamethason...
Participants
- Patients referred to one of the participating centers (listed in the Appendix) were eligible for the study if they were 17 years of age or older, had suspected meningitis in combination with cloudy cerebrospinal fluid, bacteria in cerebrospinal fluid on Gram's staining, or a cerebrospinal fluid leukocyte count of more than 1000 per cubic millimeter. Patients were excluded if they had a his…
Operation
- The study protocol was approved by the institutional review board of each participating hospital. All patients or their legally authorized representatives gave written informed consent before enrollment. Patients were enrolled between June 1993 and December 2001. The study was designed, conducted, and analyzed independently of any companies.
Administration
- Patients were randomly assigned to receive dexamethasone sodium phosphate (Oradexon), at a dose of 10 mg given every six hours intravenously for four days, or placebo that was identical in appearance to the active drug. The study medication was given 15 to 20 minutes before the parenteral administration of antibiotics. After the interim analysis, the protocol was amended to …
Treatment
- Balanced treatment assignments within each hospital were achieved with the use of a computer-generated list of random numbers in blocks of six. The code was not broken until the last patient to be enrolled had completed eight weeks of follow-up. Treatment assignments were concealed from all investigators, but in an emergency, investigators had access to the sealed, opaque enve…
Diagnosis
- Routine examination and cultures of blood and cerebrospinal fluid were performed before the initiation of antibiotic treatment. On day five, routine blood chemical tests were performed, including measurement of glucose and hemoglobin levels. As part of routine surveillance, the Netherlands Reference Laboratory for Bacterial Meningitis performed in vitro testing of cerebros…
Results
- The primary outcome measure was the score on the Glasgow Outcome Scale eight weeks after randomization, as assessed by the patient's physician. A score of 1 indicates death; 2, a vegetative state (the patient is unable to interact with the environment); 3, severe disability (the patient is unable to live independently but can follow commands); 4, moderate disability (the pat…
Signs and symptoms
- Classic symptoms and signs of meningitis were present in a large proportion of the patients (headache in 94 percent, fever in 81 percent, and neck stiffness in 94 percent). At base line, the clinical characteristics and the results of laboratory tests were similar in the dexamethasone and placebo groups, although a higher percentage of patients in the dexamethasone group had seiz…
Medical uses
- Table 4 shows the relative risk of an unfavorable outcome according to the severity of disease (as indicated by the score on the Glasgow Coma Scale on admission). Dexamethasone appeared to be most beneficial in patients with moderate or severe disease.
Adverse effects
- Adverse events resulted in the early withdrawal of four patients in the dexamethasone group and one in the placebo group (Figure 1). In the dexamethasone group, two patients were withdrawn because of severe hyperglycemia, one because of suspected stomach perforation (which was not the case), and one because of agitation and flushing. One patient in the placebo group was with…
Controversy
- The possibility of selection bias was a matter of concern in the study. To control for selection bias, we compared the base-line characteristics of patients enrolled in the study with prospective data from our nationwide cohort of 634 adults with acute bacterial meningitis. Patients in that cohort, for whom data were collected in the period from 1998 to 2002, were not included in the p…
Risks
- A delay in initiating antibiotic therapy was also a matter of concern. Informed-consent procedures can delay the initiation of antimicrobial therapy, which may lead to a poor outcome.17 In addition, cranial CT should be performed before lumbar puncture in order to rule out brain shift in patients with coma, papilledema, or hemiparesis in whom meningitis is suspected. Lumbar puncture incr…